Provider Demographics
NPI:1255478905
Name:DICKERSON, JOHN E (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:8611 N BLACK CANYON HWY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4105
Mailing Address - Country:US
Mailing Address - Phone:602-358-7429
Mailing Address - Fax:602-358-7434
Practice Address - Street 1:1731 W BASELINE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5730
Practice Address - Country:US
Practice Address - Phone:480-775-6733
Practice Address - Fax:480-775-6641
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ5526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0249831Medicare UPIN